Terminal
In Person Payment Form
Client Name
*
First Name
Last Name
Client ID
Email
*
example@example.com
Department
*
Please Select
CHED
EH
ADMIN
County
*
Please Select
Clinton
Montcalm
Gratiot
Total Payment
*
prev
next
( X )
USD
In Person Payment
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Save
Submit
Should be Empty: